Washington, DC; September 4, 1997 -- Using the same methods that he pioneered as U.S. Surgeon General to fight the AIDS epidemic, Dr. C. Everett Koop is now aiming to put directly into the hands of ordinary Americans very specific medical information on the treatment of obesity, the serious disease that currently affects more than one-third of the adult population.
Through his anti-obesity crusade, Shape Up America!, Dr. Koop has produced Healthy Weight, Healthy Living, the first reference manual that puts into layman's terms the same facts about the diagnosis and treatment of obesity that U.S. physicians are now using in their medical practices. Specifically, the booklet translates for the American public the comprehensive medical guidance for the treatment of obesity which Dr. Koop issued last year to help practitioners intervene and treat their overweight patients based on the person's degree of health risk. As such, this patient manual describes the serious complications of obesity and details for the lay person the facts behind the range of different treatment options now available.
"The best way to combat obesity is to turn overweight Americans into patient activists," said Dr. Koop. "As with other public health threats, this nation will only be successful in reducing obesity rates when patients are brought into the decision making process and are given the facts they need to reduce their weight-related health risks."
To carve out this new role for patients, Shape Up America's new consumer guide starts at the beginning: by teaching overweight Americans how to determine their weight-related health risks. Specifically, the manual encourages every American to learn his or her Body Mass Index -- or BMI -- a measurement that takes into account both height and weight. Calculated as weight in kilograms divided by height in meters squared, BMI is considered a good estimate of body fat for most adults between the ages of 19 and 70 years. Using U.S. government criteria, a BMI of 20 to 25 is considered a healthy range while a BMI of 26 or 27 is in the cautionary zone. Above a BMI of 27, a person's health risk increases with each BMI level.
"I am on a personal crusade to get every American to learn his or her BMI. Pounds on a scale are no longer a satisfactory indicator of unhealthy weight. For the majority of Americans, the more useful indicator is BMI which can tell people immediately if their weight puts them at increased risk of disabling diseases, serious illness and early death. Knowing your BMI is just as critical as knowing your cholesterol count and blood pressure," said Dr. Koop.
With the goal of educating Americans about other warning signs associated with unhealthy weight, the consumer guide further identifies these factors which can increase the health risks associated with obesity:
Taking these factors into account, the consumer guide then provides detailed information on two courses of action: weight reduction or the prevention of weight gain. Regarding losing weight, the manual suggests aiming for a BMI that is no more than two units below a person's current BMI. This goal, which is readily achievable for most adults, is equivalent to a weight loss of 5 to 10 percent of the individual's initial body weight. Towards this end, the guide recommends these specific treatment options depending upon the person's degree of health risk:
|Weight-Related Risk||Treatment Options|
|Minimal and Low Risk||Attention to diet and increased physical activity|
|Moderate Risk||As above plus low calorie diet (800 to 1200 calories a day)|
|High and Very High Risk||As above plus drug therapy|
|Extremely High Risk||As above plus surgery|
For those overweight Americans who are candidates for drug therapy, the manual cautions that drugs are not a magic bullet: rather they are effective only if the patient also changes his or her diet, physical activity level and lifestyle. On average, people who respond to prescription drugs will lose at least four pounds in the first four weeks (up to one pound per week during the first month) with the remainder of the weight loss occurring during the first six months of treatment. Studies show that on average, people who respond to drug therapy lose from 10 to 20 percent of their initial body weight while they are on the medication.
Regarding surgery, the manual advises that this treatment is only an option for people at extremely high health risk. Although the results can be very dramatic -- the average weight loss is 40 to 70 percent of the excess body weight -- the guide cautions that people who have surgery for obesity must see their doctor regularly for the rest of their lives. At the same time, surgery is only effective when it is combined with diet modification, increased physical activity and lifestyle change.
Besides weight loss options, the consumer guide tackles what is needed to prevent further weight gain. Here, the key is to establish a target BMI to maintain, and then identify ways through diet, activity and behavior modification to remain at this weight level. Some of the specific tips recommended by the guide are to:
With this new and very detailed treatment information, it is Dr. Koop's goal that overweight Americans will feel more comfortable talking to their doctors about their obesity. As Barbara J. Moore, Ph.D., President of Shape Up America!, explains it: "The Healthy Weight, Healthy Living guidelines contain a wealth of information. It will answer questions about how to get started, what questions to ask your doctor, and what practical steps will increase the odds of success. Now, both physicians and consumers have a road map to find the way to successful weight management."